Apparatus for fixing fractures of the femur

ABSTRACT

Apparatus for fixing fractures of the femur includes a plate which is held by screws to the upper part of the femur and a channel like member fixed to the proximal end of the plate for slidingly engaging a flanged nail which is driven into the head of the femur. A second embodiment substitutes a cannulated pin which is inserted into the intramedullary canal of the femur.

llnited States Patent [72] Inventor Jose Luis Orlich Apartado 81, SanJose, Costa Rica [21] Appl. No. 714,661 [22] Filed Mar. 20, 1968 [45]Patented Feb. 9, 1971 [32] Priority Nov. 8, 1967 [3 3] Costa Rica [3 l1,660

[54] APPARATUS FOR FIXING FRACTURES OF THE FEMUR 3 Claims, 8 DrawingFigs.

[5 2] US. Cl 128/92 [51] Int. Cl A61f 5/04 [50] Field of Search...1225/92 B-B3, C-C, D, F

[56] References Cited UNITED STATES PATENTS 2,612,159 9/ 1952 Collisonl. 128/92 2,621,653 12/1952 Briggs 128/92 2,761,444 9/1956 Luck 128/923,433,220 3/1969 Zickel 128/92 FOREIGN PATENTS 195,043 1963 U.S.S.R.128/92 893,401 6/1944 France 128/92 OTHER REFERENCES Journal of Bone &Joint Surgery p. 7 Jan. 1955 Journal of Bone & Joint Surgery p. 38, Oct.1951 Journal of Bone & Joint Surgery p. 162, Feb. 1952 PrimaryExaminer-Adele M. Eager Assistant Examiner-J Yasko AttorneySeidel andGonda ABSTRACT: Apparatus for fixing fractures of the femur includes aplate which is held by screws to the upper part of the femur and achannel like member fixed to the proximal end of the plate for slidinglyengaging a flanged nail which is driven into the head of the femur. Asecond embodiment substitutes a eannulated pin which is inserted intothe intramedullary canal of the femur.

PATENIEDFEB slsn 3.5614437 sum 1. or 2 25 FIG; I

' .1055 LUIS ORL ICH ATTORNEYS.

PATENTED FEB 9|91| sum 2 0F 2 INVENTOR JOSE LUIS ORL/CH ATTORNEYS.

g V APPARATUS FOR FIXING FRACTURES OF THE FEMUR This invention relatesto apparatus for fixing lesions consisting primarily of fractures of thefemur. More particularly, it relates to a pin and plate which may beused in combination with a flanged nail to fix fractures of the upperextremity ,of the femur which includes the head, the neck and thetrochan' ters.

Fractures of the femur, particularly fractures of the upper or proximalendof the femur are rather common. It was early determined that thesetting of such fractures by using casts was not likely to be verysuccessful. Thereafter,attempts were made at internal fixation throughthe use of round or polygonal nails. But this type of treatment wasabandoned because it brought about partial and temporary fixation only.Then in the late twenties, it was discovered that good fixation could beachieved by using a flanged nail. This nail has come to be known as theSmith-Petersen nail after its inventor.

Soon after the development of the Smith-Petersen nail and itsequivalents, it was determined that even better fixation of the fracturecould be achieved by attaching a plate to the shaft of the femur. Theplate produced particularly good results in the cases of fractures ofthe trochanteric region. However, such plates are rigidly fixed to theend of the nail thereby complicating their attachment to the femur andmaking it impossible for the nail to slide back on the plate to provideimpaction at the fracture site. In addition, such devicesdo not allowthe patient to be mobilized as soon as he should. This is because therigid fixation of the apparatus, which on muscle tension or on weightbearing, applies a force to the nail which may cause it to move mediallyand penetrate the head or neck of the femur, or the reactive force maytear the plate loose from the shaft of the femur. This condition existsbecausethe known prior art apparatus does not allow for a shortening ofthe apparatus. In the absence of a sliding mechanism, the patient has towait until callus is fonned. The results of remaining too long in asedentary position are well known to those in the medical profession. Itis particularly hazardous for geriatrics, the group of persons mostlikely to incur fractures of the femur, because they readily contractpneumonia, pulmonary stasis, decubitus ulcers, or generalized weakness.

In accordance with the present invention, the disadvantages of priorplates and other devices attached to the shaft for use in combinationwith a Smith-Petersen nail or its equivalent are overcome by providingnewand unobvious apparatus. In accordance with the present invention,the apparatus which is fixed to the shaft of the femur slidingly engagesthe fixation nail, thereby permitting impaction at either the fractureor the osteotomy site, or both. The patient can be immediately mobilizedwhich promotes impaction and therefore provokes osteogenesis thatresults in the formation of callus. In addition, the apparatus permitspositioning of the channel member that retains the nail in a positionthat promotes healing.

Some of the advantages of the apparatus for fixing fractures of thefemur described herein can be stated as follows:

The apparatus permits treatment of different types of bone lesionincluding fractures, osteoarthritis, and hip fusion;

The apparatus permits immediate weight bearing by the patient;

The apparatus gives a strong immobilization of the parts of the bone;

' The apparatus allows for good alignment of the parts of the bone; I

The apparatus permits impaction of the parts of the bone;

The apparatus promotes faster and better healing;

When used with the operative technique described herein, the apparatusimproves stability by permitting the shifting of the weight bearing lineto a more perpendicular one since the shaft is displaced medially; and

The apparatus promotes good fixation and healing of even the unstabletranstrochanteric fractures which are a type of fracture that is poorlyheld by most of the conventional apparatus.

For the purpose of illustrating the invention, there are shown in thedrawings forms which are presently preferred; it

being understood, however, that this invention is not limited to theprecise arrangements and instrumentalitiesshown.

FIG. I is a perspective view of the first embodiment of this inventionshowing a Smith-Petersen nail and plate.

FIG. 2 is a transverse sectional view of the apparatus shown in FIG. 1taken along the line 2-2. 4

FIG. 3 is a transverse sectional view of the apparatus shown in FIG. 1taken along the line 3-3.

FIG. 4 is a posterior surface view of a femur showing the apparatuspositioned thereon to fix an intracapsular fracture.

FIG. 5 is anelevational view of the second embodiment of the presentinvention showing a Smith-Petersen nail positioned on a pin forinsertion into the intramedullary canal.

FIG. 6 is a transverse sectional view of the apparatus shown in FIG. 5taken along the line 6-6.

FIG. 7 is a transverse sectional view of the apparatus shown in FIG. 5taken along the line 7-7.

FIG. 8 is a view of the posterior surface of the femur showing theapparatus of FIG. 5 in position to fix a transtrochanteric fracture.

Referring now to the drawings in detail, wherein like numerals indicatelike elements, there is shown in FIG. I the first embodiment of theapparatus for fixing fractures of the femur designated generally as 10.

As shown, the apparatus includes a nail 12 of the Smith- Petersen type.The nail l2 conventionally includes a head 14 which is adapted tocooperate with an impacting tool which will drive it into the bonestructure of the femur. The nail body 16 supports three flanges 18, 20and 22 which extend substantially the entire length of the nail and areequidistantly spaced apart at angles of The Smith-Petersen nail istypical of the type of flanged nail commonly used to fix fractures ofthe femur. It should be understood, however, that there are otherwell-known types of nails which perform equivalent functions such asdiamond shaped nails similar to the Hansen-Street nail used in surgeryfor reducing fractures of the shaft of the femur. Such equivalent nailsmay have specialized modifications but are still basically flangednails. Accordingly, the Smith-Petersen nail should be regarded asexemplary rather than limiting. l

' The nail I2 is supported at the end of the plate 24 by a channelmember 26. Plate 24 is elongated and provided with a plurality ofchamfered holes 28 through which the screws 30 may beinserted forsecuring the plate to the shaft of the femur. As shown in FIG. 3, theplate 24 is curved about its longitudinal axis so as to match itssurface to the curved surface of the lateral aspect of the femur. Itshould be noted that the shaft of the human femur is generallycylindrical'and of substantially uniform diameter above center.Accordingly, little difficulty should be encountered in fitting theplate 24 to the shaft of any femur.

The plate 24 is bent at its upper or proximal end to provide asupporting surface 32 for the channel member 26. Channel member 26 whichis defined by upper and lower boundaries 33 and 35 is fixed to thesupporting surface by any conventional method of joining metallicelements.

As best shown in FIGS. I and 2, the channel member 26 is a unitary pieceof metal which has been bent or otherwise deformed to define a channelhaving an open trefoil cross-sectional shape. The trefoil or cloverleafcross-sectional shape has been foundto provide excellent rigidity forthe device while simultaneously being capable of slidingly retaining thenail. The position of the nail 12 in the channel member 26 is best shownin FIG. 2.

The length of the channel member is sufficient to enable it to slidinglyengage the nail 12 so as to prevent any lateral displacement thereof. Aspositioned on the supporting surface 32, the upper and lower boundariesof channel member 26 extend laterally well beyond the concave surface ofthe plate 24 and at least a portion of the boundaries extend laterallyoutward from the convex surface of plate 24. Accordingly, the channelmember must necessarily be positioned well below what would normally bethe trochanteric region of the femur and thereby provide good support.Other types of known plates mount the nail engaging portion well outsidethe axis of the shaft thereby reducing their supporting capability.

The angle between the longitudinal axis of the channel member 26 and thelongitudinal axis of the plate 24 can be varied in accordance with therequirement of the case. ln ordinary cases requiring only the repair ofan intracapsular or trochanteric fracture, the preferable angle is 150as measured between the longitudinal axis of the plate 24 and thelongitudinal axis of the channel member 26. This angle is taken in thefirst and fourth quadrant of coordinates intersecting at the junction ofthe aforesaid longitudinal axes. While 150 is the preferred angle forfixation of routine fractures, it is anticipated that the angle betweenthe two longitudinal axes may vary from 115 to 170 depending upon thetype of operation being perfonned. For example, in cases of hiparthrodesis, an angle of 170 may be required. ln cases of osteoarthriticlesions, the angle varies depending upon whether the head is found inthe varus or valgus position.

By way of example, but not of limitation, the dimensions of the plate 24and channel member 26 can be as follows:

Width of plate 24 15 mm.

Thickness of plate 24 2.5mm.

Depth of curvature of plate 4.5mm.

Diameter of holes 28 mm.

Diameter of charnfer for holes 28 6.5mm.

Center to center distance between holes 28 21mm.

Length of plate 24 variable (15cm. preferred) Width of channel member 2615mm.

Thickness of channel member 26 2mm.

Depth of channel member mm.

Length of channel member 26 25mm.

The nail l2 and plate 24 are shown in position on a femur in FIG. 4. Theposition shown illustrates how the apparatus 10 may be used to fix anintracapsular fracture. Briefly summarized, the operative technique forarriving at this result is as follows:

A. The patient is placed in a prone position on a conventional operatingtable with slight flexion of the hip joint at about to B. The patient isgiven anesthesia. The type of anesthesia is determined by theanesthesiologist but an epidural anesthesia is to be preferred. Thistype of anesthesia is best for older persons and the position of thepatient on the operating table is suitable for rendering the same.

C. A posterio-lateral incision is made. This incision is similar to thetype sometimes called the southern approach or Moore incision. Thegluteus maximus and tensor fascia lata are divided along the line ofincision. The vastus lateralis and all external rotator muscles areseparated by blunt bisection from their insertions. The joint capsule isopened by a midlongitudinal incision so that the entire proximal end ofthe femur is exposed.

D. An osteotomy is done at the intertrochanteric region designatedgenerally by the numeral 40. This allows medial displacement of theshaft 42 of the femur.

E. The angle of the channel member 26 is chosen according to the type offracture or lesion being treated. In the embodiment shown, the femurisnormal in the fracture of the intracapsular type. Accordingly, a 150 ngle is chosen.

F. The plate 24 is screwed to the lateral aspect of the femur shaft 42.

G. A guide hole is drilled through the trochanten'c region 40, the neck44 and the head 46.

H. Thereafter, a nail 12 of the correct type and size is slid into thechannel member 26 and then driven firmly into the head 46. In certaincases where it is desirable to immobilize the entire joint, such ascases of arthrodesis, a nail as long as 20 centimeters may be used. Thisnail is driven through the head and into the iliac bone at theacetabulum. It may be driven into the iliac bone as far up as thesacroiliac joint.

l. The joint capsule is closed and all muscles, facia and skin aresutured in the conventional manner.

J. Finally, impaction of all fragments is done while the patient remainson the operating table. This is done by striking at the patients heelwith the leg straight. This impacts the fracture and immediate weightbearing can be started on the followi g day.

The advantage f permitting the nail 12 to slide back on the angledchannel 26 is that it allows for impaction at the fracture site or atthe osteotomy site. The entire apparatus, including the plate 24 andnail 12 results in proper alignment of the joints, impaction and fullimmobilization of the fracture treated. By using an osteotomy toposition the plate, healing is promoted by accelerating osteogenesisbecause more raw bone surface is in contact at the fracture site. Theosteotomy improves stability by shifting the weight bearing line to onethat is more perpendicular as a result of the shaft 42 being displacedmedially The entire operative procedure is relatively simple to perfonnand the time of performance is relatively short. In most cases, theplate 24 and pin 12 can be placed in 1 hour. No X- ray control isrequired because the hip joint is entirely exposed.

lt should be understood the foregoing has been described in respect toan intracapsular fracture with a brief reference to arthrodesis, but theapparatus and technique for applying it are equally applicable to othertypes of fractures such as transtrochanteric fracture or anextracapsular fracture with equal facility.

Referring now to FIGS. 5, 6, 7 and 8, there is shown a second embodimentof the present invention. In this embodiment, the plate 24 is replacedby a pin 50 which supports a nail 12 in a channel fixed at its proximalend. The nail 12 is of the Smith-Petersen type and includes a head 14, abody 16 and flanges 18, 20 and 22. As shown in FIG. 6, the nail I2 isretained in a channel member 52 which is positioned on the proximal endof the pin 50. The pin 50 is cannulated and has an open trefoilcross-sectional shape so as to define three flanges 54, 56 and 58. Thecannulated shape of the pin 50 permits it to be inserted into theintramedullary canal of the femur shaft without interferring with theoverall function of that canal. The trefoil shape which defines thethree flanges 54, 56 and 58 prevents the pin from rotating once it isinserted in the intramedullary canal.

An opening in the fon'n of a slot 60 is formed in the central flange 56of the pin 50 adjacent the junction with the channel member 52. Thelongitudinal axis of the slot 60 is parallel to the longitudinal axis ofthe pin 50 and in the same plane as the longitudinal axis of the channelmember 52. The slot 60 permits the insertion of a screw 62 whichcooperates with the slot to prevent rotation of the pin 50. The use ofan elongated slot (one that is substantially longer than the diameter ofscrew 62) permits the pin 50 to sink into the medullary canal whenimpaction occurs at the fracture site. To properly take advantage ofthis sinking feature, the screw 62 must extend through the slot 60adjacent the end which is remote from the channel member 52.

The channel member 52 is formed as an integral part of the pin 50 and assuch flares outwardly and inwardly to define an open trefoilcross-sectional shape as illustrated in FIG. 6. The channel member 52receives and retains the nail 12 in the manner shown in FIG. 6 and asdescribed above with respect to the channel member 26. It should benoted, however, that the channel member 52 extends laterally only to oneside of the pin 50. This is the side opposite the flange 56. The angleof the longitudinal axis of the channel member 56 with respect to thelongitudinal axis of the pin 50 is obviously the same as that describedwith respect to the plate 24 and channel member 26 and measured in thesame manner.

By way of example, but not of limitation, the following dimensions maybe used in constructing the pin 50 and its integral channel member 52:

Length of pin 50 from lower end to junction with channel member 52variable, 15cm. being preferred.

Wall thickness of pin 50 2mm.

Outside height and outside depth of cross section of pin 50 variablebetween 9 to 14mm.

- Length of slot 60 25mm.

Width of .slot 60 4mm. Length of channel member 52 25mm. Width ofchannel member 52 15mm. Wall thickness of channel member 52 2mm. Outsidedepth of channel member SZ lOmm. The method of applying the pin 50 andnail 12 is substantially identical with that described above withrespect to the plate 24 and nail 12. The only variation is in step Fwherein the proper size pin is selected according to the size of theintramedullary canal and placed into such canal. The pin is held inplace bythe medullary canal and rotation is prevented by one screw 62that extends through the slot 60 adjacent its remote end. Otherwise theoperative technique is identical.

The pin 50 is shown in position within the intramedullary canal of theshaft 42 of the femur in H6. 8. In FIG. 8, the pin 50 and nail 12 areused to fix a transtrochanteric fracture of the femur, but other typesof fractures could be fixed. As shown in FIG. 8, the position of the pin50 and channel member 52 are well placed to support the nail.l2 andhence promote good fixation of the fracture.

The operative technique in placing the pin 50 is somewhat faster thanthe time required to place the plate 24. Since only one screw is used,the entire operative technique can normally be completed in 45 minutes.

From the foregoing, it must be apparent that each of the describedembodiments of this invention accomplish three basic functions necessaryto properly fix a fracture of the femur. The apparatus a provides good,strong immobilization of the bone pans, b permits alignment of the boneparts and c allows impaction of the bone parts. The conjunction of theforegoing three factors produces better healing.

From the foregoing, it can be seen that there has been describedapparatus for fixing fractures of the femur which accomplishes theadvantages set forth above. Both embodiments can be used to treat any ofthe several types of hip lesions such as osteoarthritic conditions,fractures and arthrodesis of the hip joint. Both embodiments permitimmediate weight bearing after surgery and both permit almost perfectalignment, impaction and immobilization of the bone fragments. Thenatural result of the foregoing is to times.

With respect to intracapsular fractures, both embodiments preventnonunion of the femur neck which are frequent when other conventionaldevices are used because the fracture is impacted by muscle tension andprimarily because of early provide much shorter. healingweight bearing.Early weight bearing is achieved because of the sliding nail. Theosteotomy improves the line of weight bearing by medially displacing theshaft and also promotes osteogenesis. Transtrochanteric fracturesincluding the unstable ones are likewise made stable and held in placeby good callus formation. Finally, both devices permit better alignmentof the weight bearing line because the osteotomy permits the shift ofthe femural shaft while still holding it in place.

' The present invention may be embodied in other specific forms withoutdeparting from the spirit or essential attributes thereof and,accordingly, reference should be made to the appended claims, ratherthan to the foregoing specification as. indicating the scope of theinvention.

1 claim:

1. Apparatus for fixing fractures of the femur comprising a nail to bedriven into the proximal extremity of the femur, an elongated plate,said plate being curved about its longitudinal axis to define a concavesurface and a convex surface, a plurality of holes extending throughsaid plate for accepting screws so that said plate can be' secured tothe shaft of the femur, a member defining an elongated open channelhaving upper and lower boundaries fixed at one end of said plate, thelongitudinal axes of said channel and said elongated plate defining anobtuse angle, said upper and lower boundaries of said channel extendingoutwardly beyond said concave surface and outwardly beyond said convexsurface so that loads relative rotation therebetween.

2. Apparatus for fixing a fracture of the femur comprising a nail to bedriven into the upper extremity of the femur, an elongated pin to beinserted into the intramedullary canal of the femur, a member definingan open channel fixed at one end of said elongated pin, the longitudinalaxes of said channel and said elongated pin defining an obtuse angle,said nail being received in said channel for relative sliding movementtherebetween along said nail, an elongated opening disposed along thelongitudinal axis of said elongated pin, said elongated opening beingremote from said channel, and said nail and said channel having mutualinterlocking cross sections to prevent relative rotation therebetween.

3. Apparatus as defined in claim 2 wherein said opening is an elongatedslot, an elongated fastening member to be inserted in the femurtransversely of said elongated pin and be received in said elongatedslot, and the length of said slot is substantially greater than thewidth of said fastening member to permit said elongated pin to'movelongitudinally relative to said fastening member.

1. Apparatus for fixing fractures of the femur comprising a nail to bedriven into the proximal extremity of the femur, an elongated plate,said plate being curved about its longitudinal axis to define a concavesurface and a convex surface, a plurality of holes extending throughsaid plate for accepting screws so that said plate can be secured to theshaft of the femur, a member defining an elongated open channel havingupper and lower boundaries fixed at one end of said plate, thelongitudinal axes of said channel and said elongated plate defining anobtuse angle, said upper and lower boundaries of said channel extendingoutwardly beyond said concave surface and outwardly beyond said convexsurface so that loads transmitted from said nail to said elongated platewill be distributed uniformly to said plate by said channel member tothereby maximize the supporting capability of said apparatus, said nailbeing received in said channel for relative sliding movementtherebetween along said nail, and said nail and said channel havingmutually interlocking cross sections to prevent relative rotationtherebetween.
 2. Apparatus for fixing a fracture of the femur comprisinga nail to be driven into the upper extremity of the femur, an elongatedpin to be inserted into the intramedullary canal of the femur, a memberdefining an open channel fixed at one end of said elongated pin, thelongitudinal axes of said channel and said elongated pin defining anobtuse angle, said nail being received in said channel for relativesliding movement therebetween along said nail, an elongated openingdisposed along the longitudinal axis of said elongated pin, saidelongated opening being remote from said channel, and said nail and saidchannel having mutual interlocking cross sections to prevent relativerotation therebetween.
 3. Apparatus as defined in claim 2 wherein saidopening is an elongated slot, an elongated fastening member to beinserted in the femur transversely of said elongated pin and be receivedin said elongated slot, and the length of said slot is substantiallygreater than the width of said fastening member to permit said elongatedpin to move longitudinally relative to said fastening member.